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Background: The Australian population is highly diverse in terms of cultural heritage, languages spoken, and geographical dispersion. Health outcomes are often worse among these culturally, linguistically, and geographically diverse populations, and this is reflected in rates of physical activity participation, with people from these groups often engaging in insufficient physical activity for health benefits. This research aimed to investigate if physical activity intervention studies conducted in Australia were (1) designed to recruit culturally, linguistically, and geographically diverse participants and (2) recruiting culturally, linguistically, and geographically diverse participants. Methods: We conducted a systematic review of physical activity intervention studies conducted in adults in Australia between 2015 and November 2022. Information relevant to inclusivity in study recruitment methods and diversity of recruited participants was extracted. Results: We identified and extracted data from 371 studies, of which 98 were protocol papers for which no follow-up data was available. Only 26 studies (7%) included methods to recruit culturally or linguistically diverse participants. Most studies (189, 51%) recruited participants from major city locations, with few studies recruiting from more remote locations. No studies included recruitment from very remote regions. Information on cultural, linguistic, or geographic diversity of participants recruited to physical activity studies was provided by 109 studies (40% of studies including results) with the majority recruiting White, English-speakers from major cities. Conclusions: Few Australian physical activity studies are designed to recruit culturally, linguistically, and geographically diverse participants. Due to limited reporting of the diversity of participants, comparisons with population-representative data are unreliable. [ABSTRACT FROM AUTHOR]

The expansion of home ownership in Australia in the second half of the twentieth century was accompanied by a new vernacular geography – the mortgage belt. From the 1970s, such belts around major cities were frequently said to be crucial to federal and state elections. This article examines where political commentary located mortgage belt areas in Sydney and Melbourne and finds that it encompassed a diverse range of places often, but not always, on their urban edges. Their residents were believed to be particularly sensitive about interest rates but also other risks. While the politics of outer suburbia has often been posited as conservative, it is argued that such areas were electorally nuanced and reflected longstanding contingency in Australia around expectations of government that stands in contrast to conservatism elsewhere. These areas also highlight the continuing significance of popular access to property ownership as a theme of Australian political history. [ABSTRACT FROM AUTHOR]

This paper explores teacher perceptions of agriculture and the subsequent influence of these perceptions on student career pursual in the sector. This quantitative study used a post-workshop survey to evaluate 185 Technology Mandatory teachers' knowledge, experience and perceptions of the agricultural sector. Participant's connection to agriculture was related to their childhood and current school locations. Childhood upbringing in a town or rural setting also impacted participants having an agriculture-related qualification, the likelihood of encouraging students to consider a career in agriculture, and an increased understanding of the job opportunities in the sector. This study highlights the importance of direct experiences with agriculture to increase teacher knowledge and perception of the sector and to encourage agriculture as a potential career for students, particularly if a teacher's childhood or school location is in a major city. The findings of this research provide preliminary evidence that formative learning experiences, exposure and education has an impact on perceptions of agriculture and these in turn are associated with teacher endorsement of careers in this area to their students. There are limited studies that highlight the current perceptions of teachers in Australia about agriculture as a career. [ABSTRACT FROM AUTHOR]

The growing trend towards young adults staying in the parental home has garnered much recent scholarly interest. However, less is known about which young adults are living at home, and the impacts this has over young adults' lives. Using The Household, Income and Labour Dynamics in Australia (HILDA) dataset, this study examines the profiles of co-residing young adults and how these have changed over the first two decades of the 21st century. It then analyses the associations between co-residence and young adults' mental health, applying a propensity score modelling approach to determine differences in mental health between young adults living at home and their counterparts living independently. Results indicate that rates of co-residence have increased over the 2000s, most steeply amongst those residing outside of major cities (by 46%), older adults (by 36%), females (by 28%), and low-income groups (by 10%). Findings show a significant negative association between co-residence and mental health (a 4-point difference on the 100-point scale, 95% CI -5.93, -2.14). However, the greatest differential in mental health between co-resident and independent young adults is observed amongst those for whom rates of co-residence have increased most dramatically, i.e., females and older adults (a 6-point difference in mental health) and residents of regional and rural areas (a 5-point difference in mental health). We situate this discussion in the context of intensifying housing market constraints, considering how the transformation of the Australian housing system into a vehicle for wealth accumulation has generated barriers to residential independence. [ABSTRACT FROM AUTHOR]

An assessment of the total number, demographics and geographic distribution of optometrists in Australia may inform policy to address the maldistribution of the workforce. Concerns have been expressed about the growth of the optometry workforce in the context of, in the last decade, the establishment of four new optometry programs in addition to the three long-standing programs. This paper analysed data obtained from the Australian Health Practitioner Regulation Agency about registered optometrists during the period 1 January 2012 to 31 December 2019. The de-identified dataset included information about registered optometrists in Australia: their first year of registration, gender, year of birth (in five-year bands), optometry qualification, registration type including endorsement for therapeutic practice and the postcode of the principal place of practice. Data for 6,596 registrants were obtained over the study period during which the number of female optometrists increased significantly. The age profile of the profession shifted, with younger age bands becoming a significantly greater proportion of the profession. The majority of the profession comprised optometrists with a qualification from one of the three long-standing Australian optometry programs. Graduates of those programs accounted for 75.1% of registered optometrists in 2019, while 14.3% held a qualification from an overseas institution. The proportion of optometrists practising in major Australian cities was greater than the proportion of the population in those locations. A concomitant low proportion of optometrists, relative to population size, was found in regional and remote areas. Optometrists practising in Australia can be generalised as mostly female graduates of one of the three long-standing optometry programs holding general registration with a therapeutic endorsement, and with a principal place of practice located in a major Australian city. A significant maldistribution of the workforce was found that did not change significantly during the study period. [ABSTRACT FROM AUTHOR]

Hail damage is a leading cause of insured losses in Australia, but changes in this hazard have not been robustly quantified. Here, we provide a continental-scale analysis of changes in hail hazard in Australia. A hail proxy applied to reanalysis data shows that from 1979–2021 annual hail-prone days decreased over much of Australia but increased in some heavily populated areas. For example, the annual number of hail-prone days increased by ~40% around Sydney and Perth, the largest cities on Australia's east and west coasts, respectively. Changes in atmospheric instability have driven the trends. Radar observations, while covering shorter time spans and a more limited area than the reanalysis, corroborate the broad pattern of results. This study shows consistent hail-frequency trends in radar indicators and atmospheric environments and demonstrates substantial increases in hail frequency in major Australian cities where hail impacts are most significant. [ABSTRACT FROM AUTHOR]

Opioid analgesics prescribed for the management of acute pain following orthopaedic surgery may lead to unintended long-term opioid use and associated patient harms. This study aimed to examine the prevalence of opioid use at 90 days after elective orthopaedic surgery across major city, regional and rural locations in New South Wales, Australia. We conducted a prospective, observational cohort study of patients undergoing elective orthopaedic surgery at five hospitals from major city, regional, rural, public and private settings between April 2017 and February 2020. Data were collected by patient questionnaire at the pre-admission clinic 2–6 weeks before surgery and by telephone call after 90 days following surgery. Of the 361 participants recruited, 54% (195/361) were women and the mean age was 67.7 years (standard deviation 10.1 years). Opioid use at 90 or more days after orthopaedic surgery was reported by 15.8% (57/361; 95% confidence interval (CI) 12.2–20%) of all participants and ranged from 3.5% (2/57) at a major city location to 37.8% (14/37) at an inner regional location. Predictors of long-term postoperative opioid use in the multivariable analysis were surgery performed at an inner regional location (adjusted odds ratio 12.26; 95% CI 2.2–68.24) and outer regional location (adjusted odds ratio 5.46; 95% CI 1.09–27.50) after adjusting for known covariates. Long-term opioid use was reported in over 15% of patients following orthopaedic surgery and appears to be more prevalent in regional locations in Australia. [ABSTRACT FROM AUTHOR]

How might notions of what is cosmopolitan be geographically reinterpreted through the diverse settlement of recent migrants and refugees in Australia? This article brings this question to bear on Springvale, a suburb in the Australian city of Melbourne, discussing the area's geographical circulation of people, businesses and products as a means of understanding the interstices between marginalised cultures or traditions and the role of architecture and the built environment in this context. Discussion of these questions involves the description of the physical and spatial environment of Springvale, concentrating on its commercial and industrial centres. In part, this illustrates the marginalisation of certain buildings and uses, but also how the process of establishing new kinds of activity and identity alters the nature of environments. The result is that these perceptually and geographically peripheral zones are paradoxically becoming centres in a diversifying metropolis, affording new nodes of usage and inhabitation that are arguably becoming sites of "local cosmopolitanism." [ABSTRACT FROM AUTHOR]

Introduction: National and international clinical practice guidelines have stratified the value of osteoarthritis (OA) interventions. Interventions with strong evidence supporting effectiveness and benefit are 'high value care'. Appointment attendance, audits and practitioner surveys are widely used to determine frequency of recommendations and adherence to high value care. Greater patient reported data is needed in this evidence base. Objective: To describe the frequency of high and low value care being recommended and undertaken by individuals awaiting OA-related lower limb arthroplasty. To examine sociodemographic or disease-related variables associated with being recommended different levels of care. Methods: A cross-sectional survey of 339 individuals was conducted in metropolitan and regional hospitals and surgeon consultation rooms across New South Wales (NSW), Australia. Individuals attending pre-arthroplasty clinics/appointments for primary arthroplasty of the hip and/or knee were invited to participate. Respondents were asked what intervention(s) they were recommended by healthcare practitioners, or other sources of information, and what they had undertaken within two years prior to hip or knee arthroplasty. Interventions were classified as core, recommended, and low value care aligned with the Osteoarthritis Research Society International (OARSI) guidelines. We considered core and recommended interventions high value. The proportion of recommended and undertaken interventions were calculated. We used backwards stepwise multivariate multinomial regression to address aim three. Results: Simple analgesics were most frequently recommended (68% [95% CI 62.9 to 73.1]). 24.8% [20.2 to 29.7] of respondents were recommended high value care only. 75.2% [70.2 to 79.7] of respondents were recommended at least one low value intervention. More than 75% of recommended interventions were undertaken. Respondents awaiting hip arthroplasty, living outside a major city and without private health insurance had greater odds of recommended rather than core interventions being advised. Conclusion: While high value interventions are being recommended to individuals living with OA, in most cases they are combined with recommendations for low value care. This is concerning given the high rates of uptake for recommended interventions. Based on patient reported data, disease-related and sociodemographic variables influence the level of care recommended. [ABSTRACT FROM AUTHOR]

Shigellosis is an increasing cause of gastroenteritis in Australia, with prolonged outbreaks reported in remote Aboriginal and Torres Strait Islander (hereafter "First Nations") communities and among men who have sex with men (MSM) in major cities. To determine associations between Shigella species and demographic and geographic factors, we used multivariate negative binomial regression to analyse national case notifications of shigellosis from 2001 to 2019. Between 2001 and 2019, Australian states and territories reported 18,363 shigellosis cases to the National Notifiable Diseases Surveillance System (NNDSS), of which age, sex and organism information were available for >99% (18,327/18,363) of cases. Of the cases included in our analysis, 42% (7,649/18,327) were S. sonnei, 29% (5,267/18,327) were S. flexneri, 1% (214/18,327) were S. boydii, less than 1% (87/18,327) were S. dysenteriae, and species information was unknown for 28% (5,110/18,327) of cases. Males accounted for 54% (9,843/18,327) of cases, and the highest proportion of cases were in children aged 0–4 years (19%; 3,562/18,327). Crude annual notification rates ranged from 2.2 cases per 100,000 in 2003 and 2011 to 12.4 cases per 100,000 in 2019. Nationally, notification rates increased from 2001 to 2019 with yearly notification rate ratios of 1.04 (95% CI 1.02–1.07) for S. boydii and 1.05 (95% CI 1.04–1.06) for S. sonnei. Children aged 0–4 years had the highest burden of infection for S. flexneri, S. sonnei and S. boydii; and males had a higher notification rate for S. sonnei (notification rate ratio 1.24, 95% CI 1.15–1.33). First Nations Australians were disproportionately affected by shigellosis, with the notification rate in this population peaking in 2018 at 92.1 cases per 100,000 population. Over the study period, we also observed a shift in the testing method used to diagnose shigellosis, with culture independent diagnostic testing (CIDT) increasing from 2014; this also coincided with an increase in notifications of untyped Shigella. This change in testing methodology may have contributed to the observed increase in shigellosis notifications since 2014, with CIDT being more sensitive than culture dependent testing methods. The findings of this study provide important insights into the epidemiological characteristics of shigellosis in Australia, including identification of high-risk groups. This can be used to inform public health prevention and control strategies, such as targeted communication programs in First Nations communities and places with high levels of interaction between young children, such as childcare centres. Our study findings also highlight the implications of culture independent testing on shigellosis surveillance, particularly a reduction in the availability of species level information. This emphasises the continued importance of culture dependant testing for national surveillance of shigellosis. Author summary: Shigella spp. causes gastroenteritis and is responsible for significant morbidity and mortality worldwide. In Australia, largescale shigellosis outbreaks have been reported in First Nations communities and among men who have sex with men in recent years. We undertook an analysis of the trends in shigellosis cases in Australia over a 19-year period to understand the epidemiology of the disease, including which population groups were primarily impacted, and when and where cases were occurring. We also analysed trends in the diagnostic methods used to detect shigellosis over time, to determine whether changing detection methods had any impact on the surveillance of shigellosis cases at the national level. We found that notification rates of two species of Shigella, i.e. S. boydii and S. sonnei, significantly increased over the study period; the highest notification rate of shigellosis was in young children; and that First Nations Australians were disproportionately impacted by shigellosis. We also observed a shift in the testing methods used to diagnose shigellosis, with culture independent methods increasing from 2014. Our findings will assist in targeting prevention and control interventions to the most impacted groups and highlight the continued importance of culture dependant testing for national surveillance of shigellosis. [ABSTRACT FROM AUTHOR]

Introduction: The use of telehealth has accelerated with health service delivery restrictions experienced during the COVID-19 pandemic. This research assessed learner enrolments and feedback in an introductory, online, open-access, rural-focused telehealth training course to inform future telehealth education design. Methods: Differences in enrolled learner demographics "before" (n = 331) and "after" (n = 3,776) COVID-19-related changes in Australia were assessed. Content analysis of learner feedback was conducted to understand the beneficial aspects of the course and to inform future telehealth education and training development. Results: Concurrent with telehealth changes announced in Australia in March 2020, enrolments in the course sharply increased. While students comprised most enrolments, initial growth was strongest amongst health educators and health professionals. More learners enrolled from major city areas and other countries. User feedback indicated the flexible delivery mode, policy, links to resources and multimedia content were the most beneficial aspects of the course. Learners would like more client perspectives as well as discipline- and context-specific information. There is also an appetite for more practicebased telehealth education. Conclusions: Growth in demand for the course and positive learner feedback showed it was filling an important introductory training gap. Learner feedback also highlighted several perceived barriers among learners in being able to implement best-practice telehealth in their current or future practice. This feedback could be used to inform the design of further telehealth training for health professionals and students to, ultimately, enhance the use of telehealth technologies. [ABSTRACT FROM AUTHOR]

'Counter-urbanisation' has attracted international attention for decades, as an elusive concept that runs against the overwhelming trend of an urbanising world. In Australia, interest in counter-urbanisation waned after the peak interest from the 1970s until the early 2000s, however a recent resurgence of interest has grown due to anecdotal evidence of rising migration out of major cities. Advances in the ability to telecommute, the impacts of COVID-19 and lockdowns in major cities, and the impact of climate change on migration movements are some contemporary changes prompting the need for a renewed critical and theoretical analysis of counter-urbanisation. This editorial introduces the special issue that offers renewed insights to counter-urbanisation in Australia. We present three arguments to ground the elusive concept of 'counter-urbanisation' that underpins this special issue. We argue (1) that the contemporary examples of counter-urbanisation we are witnessing presently in Australia involve migration from major cities to regional spaces; (2) counter-urbanisation is determined by geographical context, in this case Australia and places within, and (3) Australian counter-urban movements are strongly linked to amenity and lifestyle migration. This editorial then introduces the special issue papers which together define and challenge the concept of counter-urbanisation within the Australian context. [ABSTRACT FROM AUTHOR]

Many motives for undertaking a counter-urban move appear to be associated with a search for a sense of 'home', such as moving for a sense of community, for affordable or larger housing, perceptions of a 'safer' area for children, or moving to a childhood hometown. However, rarely is counter-urban migration directly linked to the concept of home. In this paper, I make the direct link between counter-urban moves and the search for a sense of home using biographies of four (4) counter-urban movers to the Sunshine Coast, Australia. The participants each moved to the area in a search for a sense of home related to four key themes: housing, family, stability and familiarity, however they varied in their pre-move experiences and expectations of how the Sunshine Coast would improve their sense of home. These differences impacted their post-move experiences, as those participants with prior familiarity with the Sunshine Coast felt a greater sense of home post-move. This paper provides an important conceptual link between the search for a sense of home and counterurbanisation, to add further critical insight into motivations and experiences of counter-urban migrants, and the perceptions of a sense of home being better achieved outside of major cities.. [ABSTRACT FROM AUTHOR]

• Ethnic inequalities in green space accessibility are remarkable in Australia. • Disadvantaged neighborhoods have lower green space accessibility in larger cities. • Green space is related to better health in the national capital and global cities. • Keeping reasonable walking distances to green space is health beneficial. Green space accessibility is a crucial environmental justice issue, which is influenced by socio-economic factors and may lead to disparate health outcomes among individuals. While numerous scholars have examined the association between green space accessibility and socio-economic status or health separately, research on the pathways linking these three dimensions remains relatively sparse. Using Statistical Area Level 1 (SA1) data from eight Australian capital cities, this study explores the pathways from socio-economic status to green space accessibility and subsequently to diverse health outcomes. The findings indicate the limited green space accessibility in some socio-economically disadvantaged neighborhoods, particularly among ethnic minorities and in larger cities. Additionally, a significant association is observed between increased green space accessibility and reduced chronic diseases in the national capital and major global cities. Regarding spatial proximity, the study suggests that green spaces do not need to be immediately adjacent to residential areas but can be planned within reasonable walking distances to confer significant health benefits. These findings can inform the development of equitable green space planning policies and contribute to improved human health. [ABSTRACT FROM AUTHOR]

Objectives: To examine adherence to Australian Health Practitioner Regulation Agency (AHPRA) and Australian Orthopaedic Association (AOA) advertising guidelines by AOA members. Design, setting: Cross‐sectional survey, Australia. Participants: Two samples of AOA member orthopaedic surgeons: 81 randomly selected from a list of AOA members with publicly available contact details (AOA random sample); and a sample obtained by searching with Google for "orthopaedic surgeon" and the name of the major city in each of the eight Australian states and territories in turn; the top eight results for each search were considered for inclusion (AOA Google sample). Main outcome measures: Non‐compliance of advertising material, by surgeon sample, with the AHPRA and AOA guidelines; associations between non‐compliance and sample, state, location (metropolitan, regional), and subspecialty. Results: Of the 81 surgeons in the AOA random sample, 52 (64%) were non‐compliant with at least one aspect of the AHPRA guidelines, and 53 (65%) were non‐compliant with at least one aspect of the AOA guidelines. Of the 59 surgeons in the AOA Google sample, 48 were non‐compliant with the AHPRA guidelines (81%) and 46 with the AOA guidelines (78%). Incidence of non‐compliance with the AHPRA guidelines was influenced by sample source (AOA Google v AOA random: incidence rate ratio [IRR], 1.37; 95% CI, 1.01–1.87), but not non‐compliance with the AOA guidelines (IRR, 1.09; 95% CI, 0.77–1.55). Conclusion: A large proportion of AOA members who advertise online do not comply with AHPRA and AOA advertising guidelines. [ABSTRACT FROM AUTHOR]

In Australia, telehealth is not new, with several telehealth specialist services being available for those living in rural and remote communities. However, prior to the COVID-19 pandemic, telehealth was not routinely available for primary care or urban specialist appointments. There has been an increased focus in the use of telehealth within primary care, and particularly general practice, but overall, there has been limited research to date to guide telehealth best-practice based on consumer experiences and preferences within these settings. We aimed to capture the consumer experience of telehealth during the COVID-19 pandemic, through a novel Kitchen Table Discussion (KTD) method. This increases access to a broader community consumer cohort, with consumer hosts leading discussions in a safe environment. The KTDs were conducted in May 2021, with 10 community members each hosting a group of up to 10 participants. A total of 90 participants took part from across Australia, with the majority living in major cities, although a significant proportion lived in inner and outer regional areas of Australia, or had experience living in rural, regional or remote areas. Seventy percent of participants reported using telehealth in the past. Data were analysed sequentially using thematic analysis and identified key themes: modality, convenience, access, wait time, existing relationship, communication, connectivity, cost, and privacy. Overall, the future of telehealth looks hopeful from the perspective of the consumer, but significant improvements are required to improve consumer engagement and experience. It is evident that 'one size does not fit all', with results suggesting consumers value the availability of telehealth and having choice and flexibility to use telehealth when appropriate, but do not want to see telehealth replacing face-to-face delivery. Participants tended to agree that telehealth was not a preferred method when physical examination was required but would suit certain points of the patient journey. [ABSTRACT FROM AUTHOR]

Wastewater analysis provides a complementary measure of alcohol use in whole communities. We assessed absolute differences and temporal trends in alcohol consumption by degree of remoteness and socioeconomics indicators in Australia from 2016 to 2023. Alcohol consumption estimates from 50 wastewater treatment plants (WWTP) in the Australian National Wastewater Drug Monitoring Program were used. Trends were analysed based on 1) site remoteness: Major Cities, Inner Regional and a combined remoteness category of Outer Regional and Remote, and 2) using two socioeconomic indexes from the Australian Bureau of Statistics (ABS) relating to advantage and disadvantage for Income, education, occupation, and housing. Consumption estimates were similar for Major Cities and Inner Regional areas (14.3 and 14.4 L/day/1000 people), but significantly higher in Outer Regional and Remote sites (18.6 L/day/1000 people). Consumption was decreasing in Major cities by 4.5% annually, Inner Regional by 2.4%, and 3.5% in the combined Outer Regional and Remote category. Consumption estimates were higher in socioeconomically advantaged quartiles than those of lower advantage (0%-25% mean = 13.0, 75%-100% mean = 17.4). Consumption in all quartiles decreased significantly over the 7 year period with annual rates of decrease of 0.9%, 3.7%, 3.6%, and 3.0% for the lowest to highest quartile, respectively. Declines in Australian alcohol consumption have been steeper in large urban areas than regional and remote areas. There were smaller annual decreases in the most socioeconomically disadvantaged areas. If continued, these trends may increase Australian health inequalities. Policy and prevention work should be appropriately targeted to produce more equitable long-term outcomes. [Display omitted] • Wastewater estimates of alcohol consumption from 50 Australian sites, 2016–2023. • Consumption higher in regional areas and areas with higher socioeconomic status. • Consumption decreasing over time to greater degree in cities than regional sites. • Socioeconomic and remoteness factors contribute to differences in alcohol use. [ABSTRACT FROM AUTHOR]

Having begun as a short‐term rental platform in major cities, Airbnb has now extended to many remote and regional areas of Australia. One effect of this spread has been disruption to the conventional rental industry, which stimulates micro‐entrepreneurship in local communities directly through short‐term accommodation and indirectly through related industries. Given Australia's core–periphery settlement structure, resulting from the country's historical development, disruption through entrepreneurship has relatively more potential in remote and regional areas. This article uses the Porter diamond model to explain how Airbnb‐led micro‐entrepreneurship interacts with territorially embedded socioeconomic characteristics across regional and remote Australia. Drawing on Airbnb data for Australia between 2014 and 2018 at the scale of regional labour markets, we use a quantile regression model to explain the association between Airbnb‐led micro‐entrepreneurship and four distinct structural dimensions between metropolitan and non‐metropolitan regions. The analysis provides evidence that non‐metropolitan regions have certain stronger competitive advantages for attracting Airbnb‐led micro‐entrepreneurship compared with metropolitan regions, particularly across regional cities and in areas associated with mining, agriculture, and tourism. We conclude that policymakers should weigh concerns relating to peer‐to‐peer accommodation in major metropolitan regions against the purported benefits to peripheral regions. [ABSTRACT FROM AUTHOR]

• There was strong evidence of spatial variation in incidence rates for mesothelioma in Australia. • Maps of modelled incidence counts show areas of greatest demand for health services. • Modelled incidence rates were higher in major cities and lower in affluent areas. • Some patterns were consistent with historical exposures, despite long latency. To understand the geographic distribution of and area-level factors associated with malignant mesothelioma incidence and survival in Australia. Generalised linear models and Bayesian spatial models were fitted using population registry data. Area-level covariates were socioeconomic quintile, remoteness category and state or territory. The maximised excess events test was used to test for spatial heterogeneity. There was strong evidence of spatial differences in standardised incidence rates for malignant mesothelioma but survival was uniformly poor. Incidence rates varied by state or territory and were lower in remote areas. Patterns in the geographic distribution of modelled incidence counts for malignant mesothelioma differed substantially from patterns of standardised incidence rates. Geographic variation in the modelled incidence counts of malignant mesothelioma demonstrates varying demand for diagnostic and management services. The long latency period for this cancer coupled with migration complicates any associations with patterns of exposure, however some of the geographic distribution of diagnoses can be explained by the location of historical mines and asbestos-related industries. [ABSTRACT FROM AUTHOR]

Background: Australia has a universal healthcare system, yet organisation and delivery of primary healthcare (PHC) services varies across local areas. Understanding the nature and extent of this variation is essential to improve quality of care and health equity, but this has been hampered by a lack of suitable measures across the breadth of effective PHC systems. Using a suite of measures constructed at the area-level, this study explored their application in assessing area-level variation in PHC organisation and delivery. Methods: Routinely collected data from New South Wales, Australia were used to construct 13 small area-level measures of PHC service organisation and delivery that best approximated access (availability, affordability, accommodation) comprehensiveness and coordination. Regression analyses and pairwise Pearson's correlations were used to examine variation by area, and by remoteness and area disadvantage. Results: PHC service delivery varied geographically at the small-area level–within cities and more remote locations. Areas in major cities were more accessible (all measures), while in remote areas, services were more comprehensive and coordinated. In disadvantaged areas of major cities, there were fewer GPs (most disadvantaged quintile 0.9[SD 0.1] vs least 1.0[SD 0.2]), services were more affordable (97.4%[1.6] bulk-billed vs 75.7[11.3]), a greater proportion were after-hours (10.3%[3.0] vs 6.2[2.9]) and for chronic disease care (28%[3.4] vs 17.6[8.0]) but fewer for preventive care (50.7%[3.8] had cervical screening vs 62.5[4.9]). Patterns were similar in regional locations, other than disadvantaged areas had less after-hours care (1.3%[0.7] vs 6.1%[3.9]). Measures were positively correlated, except GP supply and affordability in major cities (-0.41, p <.01). Implications: Application of constructed measures revealed inequity in PHC service delivery amenable to policy intervention. Initiatives should consider the maldistribution of GPs not only by remoteness but also by area disadvantage. Avenues for improvement in disadvantaged areas include preventative care across all regions and after-hours care in regional locations. [ABSTRACT FROM AUTHOR]

Objectives: To describe the burden, geographic distribution, and outcomes of firearm‐related violence in New South Wales during 2002–2016. Design, setting, participants: Population‐based record linkag study of people injured by firearms in NSW, 1 January 2002 – 31 December 2016. Main outcome measures: Frequency, proportion, and rate of firearm‐related injuries and deaths by intent category (assault, intentional self‐harm, accidental, undetermined/other) and socio‐demographic characteristics; medical service use (hospitalisations, ambulatory mental health care) before and after firearm‐related injuries; associations between rates of firearm‐related injury and those of licensed gun owners, by statistical area level 4. Results: Firearm‐related injuries were recorded for 2390 people; for 849 people, the injuries were caused by assault (36%), for 797 by intentional self‐harm (33%), and for 506 by accidents (21%). Overall rates of firearm injuries were 4.1 per 100 000 males and 0.3 per 100 000 females; the overall rate was higher in outer regional/rural/remote areas (3.8 per 100 000) than in major cities (1.6 per 100 000) or inner regional areas (1.8 per 100 000). During 2002–2016, the overall firearm‐related injury rate declined from 3.4 to 1.8 per 100 000 population, primarily because of declines in injuries caused by assault or accidental events. The rate of self‐harm injuries with firearms were highest for people aged 60 years or more (41.5 per 100 000 population). Local rates of intentional self‐harm injuries caused by firearms were strongly correlated with those of licensed gun owners (r = 0.94). Conclusions: Rates of self‐harm with firearms are higher for older people, men, and residents in outer regional and rural/remote areas, while those for assault‐related injuries are higher for younger people, men, and residents of major cities. Strategies for reducing injuries caused by self‐harm and assault with firearms should focus on people at particular risk. [ABSTRACT FROM AUTHOR]

This commentary introduces the special section on the outcomes of the Queensland Alcohol‐related violence and Night‐time Economy Monitoring project and outlines the political and policy context of the interventions put in place under the Queensland government's Tackling Alcohol‐Fuelled Violence strategy. The development of the strategy was informed by alcohol policy initiatives trialled in other major Australian cities over the past two decades. The articles in this special section examine the impact of the Tackling Alcohol‐Fuelled Violence policy stages on alcohol‐related harms and local economies across selected entertainment precincts (Safe Night Precincts). A rich array of data were utilised, including administrative health and justice data, data reflective of nightlife trading (i.e. foot traffic data, ID scanner data and live music performances) and street surveys. Findings have implications for research, policy and practice and demonstrate the need for comprehensive evaluations that can accommodate the complexities of modern alcohol policy in Australia. [ABSTRACT FROM AUTHOR]

Introduction: There is a concern in many countries about violence from late‐night alcohol sales and appropriate regulatory responses. However, economic losses arising from this activity rarely feature in public debate. Credible estimates are lacking because economic evaluations have not taken a 'societal perspective', costing health, policing and criminal justice outcomes. Our aims were to: (i) develop an analytic model capable of informing cost–benefit analysis of policy changes; and (ii) estimate costs of alcohol‐related assault (ARA) in a major city. Methods: We employed decision‐analytic cohort models of health and judicial consequences of ARA in Sydney, Australia. We constructed two 6‐branch decision‐analytic models of patient and offender pathways through the health and judicial systems. We produced overall estimates and analysed their sensitivity to key assumptions. Results: Combining results from a Health model comprising 40 pathways and 137 cost events, and a Justice model comprising 20 pathways and 48 cost events, yielded an overall cost estimate of $85 093 per ARA, of which 64% was health‐related, while 36% was justice‐related. Estimates were sensitive to values assigned for 'pain, suffering, morbidity and wellbeing', and to costs of incarceration. Health service‐related costs accounted for 1.3% of the total. Discussion and Conclusion: The costs of ARA are significant and dominated by incidents in which a victim does not necessarily receive acute medical care but suffers loss in quality‐of‐life, and where a perpetrator is processed through the criminal justice system. Being derived transparently, within a theoretical framework, the estimates are adaptable to inform cost–benefit analyses of policy options in Australia and other countries. [ABSTRACT FROM AUTHOR]

The concentration of population in the major metropolitan cities has again become prominent in public debate in Australia. Politicians and commentators have called for an increase in the population of rural areas by improving commuter access to metropolitan employment through infrastructure investments that facilitate commuting from regional places of residence to metropolitan places of work, referred to as metro-bound commuters. This article investigates the impact of commuter-based population growth on rural communities, and particularly housing markets. Increasing rural housing markets indicate a process of gentrification, calling into question policies that promote population redistribution not underpinned by rural employment growth. [ABSTRACT FROM AUTHOR]

The importance of the application of Strategic Environmental Assessment (SEA) for policies and plans is rapidly growing and will one day make the policies and plans environmentally and socially sustainable. While there have been legal requirements for SEA process and practice available in Australia and New Zealand for more than two decades, there is a dearth of information on how SEA is working in two separate jurisdictions. This comparative study on SEA practice is an attempt to fill this gap. The SEAs of two major urban plans of two major cities of two countries were reviewed and analysed to understand the practice of the SEA process. The SEA process of two urban plans of two countries was assessed against a set of good practice criteria. In addition, interviews were conducted with key informants, who were involved in the planning process, which provided valuable information. The study identified the key characteristics of two separate models of SEA practice alongside their advantages and disadvantages. The findings indicate that there are similarities and dissimilarities in SEA practices in both jurisdictions. The key similarities include the legal requirements for SEA, including community participation, in both jurisdictions. The key dissimilarities of SEA applications include the application of two separate models where the extent of flexibility, rigidity, integrative and separate issues related to the application of SEA varies. Also, there are common shortcomings identified in practice including relatively less attention is paid to socioeconomic issues and cumulative impacts. It is expected that the comparative study will help both Australia and New Zealand to learn lessons from each other, and thereby improve the practice of SEA in their own jurisdictions. The study also provides valuable insights by revealing some key characteristics of the SEA system of both countries. The findings of this study can be useful for the improvement of SEA practice for urban policy and plan by addressing the shortcomings identified in this study in both countries, and in other jurisdictions with a similar context. [ABSTRACT FROM AUTHOR]

Objectives: To examine national variation in systemic antibiotic use in long-term care facilities (LTCFs) and identify facility characteristics associated with antibiotic utilization.Methods: This retrospective cohort study included 312 375 residents of 2536 Australian LTCFs between 2011 and 2016. LTCFs were categorized as low, medium or high antibiotic use facilities according to tertiles of DDDs of systemic antibiotics dispensed per 1000 resident-days. Multivariable logistic regression estimated the associations between facility characteristics (ownership, size, location, medication quality indicator performance, prevalence of after-hours medical practitioner services) and antibiotic use (low versus high).Results: LTCFs in the lowest and highest antibiotic use categories received a median of 54.3 (IQR 46.5-60.5) and 106.1 (IQR 95.9-122.3) DDDs/1000 resident-days, respectively. Compared with not-for-profit LTCFs in major cities, government-owned non-metropolitan LTCFs were less likely to experience high antibiotic use [adjusted OR (aOR) 0.47, 95% CI 0.24-0.91]. LTCFs with 69-99 residents were less likely to experience high antibiotic use (aOR 0.69, 95% CI 0.49-0.97) than those with 25-47 residents annually. Greater prevalence of medical practitioner services accessed after-hours was associated with high antibiotic use [aOR 1.10 (per 10% increase in after-hours services), 95% CI 1.01-1.21]. South Australian LTCFs (aOR 2.17, 95% CI 1.38-3.39) were more likely, while Queensland (0.43, 95% CI 0.30-0.62) and Western Australian (aOR 0.34, 95% CI 0.21-0.57) LTCFs were less likely to experience high antibiotic use than New South Wales LTCFs.Conclusions: Considerable facility level variation in systemic antibiotic use was observed across Australian LTCFs. Identification of facility characteristics associated with antibiotic use provides a basis for targeted stewardship initiatives. [ABSTRACT FROM AUTHOR]

In a bid to revive soccer's fortunes in Australia, the A-League was created whereby private franchises represented the country's major cities. This article examines the Melbourne Heart FC and the emotional attachment of members during its first two seasons. A survey methodology was used to identify attitudes towards the brand and the Sport Spectator Identification Scale (SSIS) measured their identification with the franchise. There is conclusive evidence that strong levels of identification can develop quickly for a new team, yet three of the scale's items made a weaker contribution. There is also a suggestion that identity is multi-layered. New sport teams need to build awareness and a fan base, however, while the SSIS has been used extensively to study established teams, its application to a newly-formed football club is less common. This article discusses how members of a new franchise in Australia's A-League quickly developed a strong emotional attachment. [ABSTRACT FROM AUTHOR]

We study changes in the spatial distribution and segregation of socio‐economic groups in Australia using a new data set with harmonised census data for 1991 and 2011. We find a general increase in residential segregation by education and occupation groups across the major capital cities in Australia. Importantly, these trends cannot be explained in general by changes in the demographic structure of groups and areas but rather by the rise in the over and underrepresentation of groups across areas. In particular, our analysis reveals clear diverging trends in the spatial configuration of high and low socio‐economic groups as measured by their occupation and education. Whereas high‐skilled groups became more concentrated in the inner parts of cities, the low‐educated and those working in low‐status occupations became increasingly overrepresented in outer areas. This pattern is observed in all five major capital cities, but it is especially marked in Sydney, Melbourne and Brisbane. [ABSTRACT FROM AUTHOR]

Sustainable Development Goal 6 seeks to address the increasing and unmet demand for water in many urban areas already struggling with inadequate water quality and supply. With climate change posing new threats, and both population growth and rural urban migration exacerbating existing issues, measures to reduce water demand sit alongside increasing water supply to address the problem. This article outlines Australia's experience in reducing water demand in urban areas, illustrating a range of measures that could contribute to meeting this goal. Key measures have a low fiscal cost, but require attention to governance. [ABSTRACT FROM AUTHOR]

Gay men and lesbian women often demonstrate unique settlement patterns, forming what have been referred to as 'gayborhoods'. This study sought to provide the first postcode-level estimates of population size and prevalence of gay and lesbian people in Australia. Data on same-gender-partnered households from the Australian Census were combined with information from six different surveys conducted from 2011 to 2017. We estimated that in 2016 there were 132,203 gay men (1.5% of adult males; 95% CI: 1.4–1.6) and 79,931 lesbian women (0.9% of adult females; 95% CI: 0.8–1.0) in Australia. While many postcodes were sparsely populated by gay and lesbian people (40.1% had prevalences of <0.1%), 24.6% were moderately populated (prevalences in the 50-95th percentile) and 2.7% were highly populated (95th percentile). By jurisdiction, the Australian Capital Territory had the highest prevalences of gay men (2.1%; 95% CI: 2.0–2.2) and lesbian women (1.5%; 95% CI: 1.4–1.6). Although the majority of highly populated postcodes were found in major cities (83.7%), some were also found in regional and remote area (16.3%). This method can be applied in other countries to enhance populate estimates. The accompanying dataset can be used to guide service delivery, conduct geographically contextualised research and develop policies relevant to gay men and lesbian women in Australia. [ABSTRACT FROM AUTHOR]

Background: Australia, unlike most high-income countries, does not have published benchmarks for cardiac rehabilitation (CR) delivery. This study provides cross-state data on CR delivery for initial benchmarks and assesses performance against international minimal standards.Methods: A prospective observational study March-May 2017 of CR programs in NSW (n=36), Tasmania (n=2) and ACT (n=1) was undertaken. Data were collected on 11 indicators (published dictionary), then classified as higher or lower performing using the UK National Audit of Cardiac Rehabilitation (NACR) criteria. Equity of access to higher performing CR was assessed using logistic regression.Results: Participants (n=2,436) had a mean age of 66.06±12.54 years, 68.9% were male, 16.2% culturally and linguistically diverse (CALD) and 2.6% Aboriginal and Torres Strait Islander peoples. At patient level, waiting time was median 15 (Interquartile range [IQR] 9-25) days, 24.3% had an assessment before starting, 41.8% on completion, a median 12 sessions (IQR 6-16) were delivered, which 59.1% completed and 75.4% were linked to ongoing care. At program level, using NACR criteria, 18.0% were classified as higher performing and ≥87.1% met waiting time criteria, however, only 20.5% met duration criteria. Evidence of inequitable access to higher performing programs was present with substantially higher odds for participants living in major cities (OR 28.11 95%CI 18.41, 44.92) and with every decade younger age (OR 1.89-2.94) and lower odds by 89.0% for principal referral hospital-based services (OR 0.11 95%CI 0.08, 0.14) and 31.0% for people having a CALD background (OR 0.69 95%CI 0.49, 0.97).Conclusions: This study provides initial national CR performance benchmarks for quality improvement in Australia. While wait times are minimised, few programs are higher performing or met minimum duration standards. There is an urgent need to resource and support CR quality and access outside of major cities, in principal referral hospitals and for older and diverse patients. [ABSTRACT FROM AUTHOR]

Background: Information about children treated in New South Wales (NSW), Australia following major injury has been limited to those treated at trauma centres using mortality as the main outcome measure, restricting assessment of the effectiveness of the Trauma System. This study sought to describe the detailed characteristics as well as functional and psychosocial health outcomes of all children suffering major injury in NSW.Methods: A longitudinal study was conducted between July 2015 and November 2017 and included children < 16 years requiring intensive care or an injury severity score (ISS) ≥ 9 treated in NSW or who died following injury. Children were identified through the three NSW Paediatric Trauma Centres (PTC), the NSW Trauma Registry, NSW Aeromedical Retrieval Registry (AirMaestro) and the National Coronial Information System (NCIS). Health-related quality of life (HRQoL) outcomes for children treated at the three PTCs were collected at baseline, 6 and 12 months using the Paediatric Quality of Life inventory (PedsQL 4.0) and EuroQol five-dimensional EQ-5D-Y.Results: There were 625 children, with a median (interquartile range) age of 7 (2-13) years and 71.7% were male. Around half were injured in major cities (51.2%). The median (IQR) injury severity score (ISS) was 10 (9-17). Twelve-month HRQoL measured by PedsQL remained below baseline for psychosocial health. Treatment costs increased with injury severity (p=<0.001) and polytrauma (p=<0.001). No survival benefit was demonstrated between PTC versus non-PTC definitive care. Injured females and children from rural / remote NSW were overrepresented in the deceased.Conclusion: Children treated in NSW following major injury have reduced quality of life and in particular, reduced emotional well-being at 12 months post-injury. Improved psychosocial care and outpatient follow-up is required to minimise the long-term emotional impact of injury on the child. [ABSTRACT FROM AUTHOR]

Background The prevalence of Neisseria gonorrhoeae (gonorrhoea) in sexual contacts of gonorrhoea has not been established, but limited data suggest that the majority of contacts are not infected. Contacts of gonorrhoea who receive empirical treatment at the point of testing may receive unnecessary antimicrobial treatment for an infection that is known to have multidrug resistance. This study evaluated patient acceptability of non-empirical treatment.?Methods: We conducted an anonymous cross-sectional survey of patients attending sexual health centres in New South Wales, Australia, on the acceptability of empirical and non-empirical treatment models and patients' concerns about antimicrobial resistance.Results: Most of the 823 survey participants were willing to wait for treatment until their results were reported; 77% and 53% would agree to wait for treatment if results were available in 2 and 7 days respectively. Participants were less likely to agree to non-empirical treatment if they lived in regional and remote areas compared with those in a major city (odds ratio (OR) 0.5; 95% confidence interval (CI) 0.35-0.73). Most participants (70%) were worried about infections becoming resistant to antibiotics, with heterosexual men and women being less likely than gay and bisexual men to be worried (heterosexual men: OR 0.64, 95% CI 0.44-0.94; women: OR 0.64 95%, CI 0.44-0.92).Conclusions: Non-empirical treatment was acceptable to most participants, but patient preference, ability to return for treatment and timeliness of results are factors that should inform individual treatment decisions. [ABSTRACT FROM AUTHOR]

Background: Renal replacement therapy (RRT) places a burden on patients, and geographical relocation for easier access to healthcare facilities is a necessity for some. Incidence and factors associated with relocation has not been comprehensively examined at a national level. We aimed to determine proportion, incidence, characteristics of RRT patients who relocate and relocation rate by remoteness of residence and dialysis modality.Methods: Retrospective cohort analysis using Australian and New Zealand Dialysis and Transplant Registry to examine RRT patients in Australia from January 2005 to December 2015. Relocation incidence was calculated for remoteness of residence and RRT modality as rate per 100 patient years. Factors associated with relocation were examined using competing risk regression models with death as a competing event.Results: Of 24,676 incident patients on RRT, 5888 (23.9%) relocated with a median time of 1.6 years [IQR 0.7-3.4] years. Relocation incidence was 7.9 per 100 patient years and increased from major cities to very remote regions (7.2 to 48.8 per 100 patient years respectively, p < 0.001). Remoteness of residence was associated with geographical relocation in competing risk analysis especially in remote (SHR 1.20, 95%CI 1.01, 1.41 p = 0.034) and very remote regions (SHR 3.51 95% 3.05, 4.04 p < 0.001). Aboriginal or Torres Strait Islander ethnicity, compared to Caucasian, was independently associated with relocation (SHR 1.18, 95% CI 1.06,1.31, p = 0.002) while transplant patients were less likely to relocate compared to haemodialysis patients (HR 0.37, 95%CI 0.34, 0.39, p < 0.001).Conclusions: Relocation in patients receiving RRT is associated with remoteness of residence, RRT modality and ethnicity. Reasons for relocation and its impact on patient wellbeing and outcome should be further explored. [ABSTRACT FROM AUTHOR]

The Australian Government's attempts at national urban policy have been sporadic and inconsistent, under the constraints of constitutional, financial, ideological and political factors. This paper concerns the recent resurgence of national urban policy under the rubric of "smart cities" adopted by the Turnbull Government and carried on by the incumbent Morrison Government. It investigates how this round of smart cities agenda articulates with Australia's political tradition of national urban policy to seek continuity and change, through comparing historical policies, unpacking major smart cities programmes, identifying explanatory factors and critically commenting on its innovation and legacy. Drawing upon these analyses, this paper argues that understanding the smart cities agenda needs to move beyond the political, ideological "to‐and‐fro" pendulum to national urban policy observed in history. Rather, it resonates with a globalised policy norm established upon the city‐based global integration and competition, driven by an imperative of transitioning to a knowledge economy and pursuing innovation capacity. It is too early to judge whether the smart cities agenda will bring changes to Australian cities in the way it wishes, since it involves long‐term infrastructure investment and urban development projects. However, a comprehensive and consistent national urban policy to govern the Australian system of cities and towns has not been established yet. [ABSTRACT FROM AUTHOR]

Purpose: The potential quality of life benefits of breast reconstruction (BR) for women who have undergone mastectomy for breast cancer have long been recognised. While many women will not want to have BR, international best-practice guidance mandates that all should be given the choice. The aim of this article is to highlight potential policies to support patients' informed discussion of BR options and to improve access to BR for women living in underserved locations.Methods: Ninety semi-structured interviews were conducted from May 2015 to May 2017 with a convenience sample of 31 breast reconstructive surgeons, 37 breast cancer health professionals and a purposive sample of 22 women who underwent mastectomy as part of their breast cancer treatment. Breast, plastic reconstructive surgeons and health professionals based in major cities also provided information about how they cared for patients from more remote areas.Results: Analysis of interview data revealed a range of barriers that were grouped into four major categories describing issues for women living outside major cities: population characteristics associated with lower socioeconomic status; locational barriers including limited health services resources and distance; administrative barriers such as hospital policies and inadequate support for women who need to travel; and surgical workforce recruitment barriers.Conclusions: Suggestions for potential solutions included the following: greater geographical centralisation of BR services within major cities; the creation of designated breast centres with minimum caseload requirements similar to the UK's system; and a buddy system, whereby smaller hospitals network with multidisciplinary teams based in larger hospitals. [ABSTRACT FROM AUTHOR]

Background: The prevalence of root caries in Australia is expected to increase due to an ageing population and increase in tooth retention. This report presents findings from the Australian National Study of Adult Oral Health 2017-18.Methods: A stratified random sample of 15 731 Australians aged ≥15 years participated in a telephone or online survey. Of those, 5022 dentate people underwent an oral assessment. Carious root surfaces were defined as ≥1 mm of affected dentine/cementum. Prevalence was defined as the percentage with ≥one natural tooth with untreated caries on root surfaces. Severity was measured as the mean number of root surfaces with caries.Results: Prevalence of untreated root caries in the Australian adult dentate population was 8.2% and increased with increasing age (range 2%-17.8%). Men (9.3%) compared to women (7.2%), people living in remote (18.0%) versus regional (9.3%) and major cities (7.6%), and those with the lowest household income (15.4%) compared to middle (7.6%) and highest tertile (3.2%) had untreated root caries. The average number of decayed or filled root surfaces in the Australian adult population was 1.1 (95% CI 0.9, 1.2).Conclusions: Root caries was associated with older age, living outside a major city and lower income. [ABSTRACT FROM AUTHOR]

Aims: To report the experience of coronal dental caries in the Australian adult population.Methods: Dentate people aged 15 years and over were online or telephone interviewed, and dental examined (n = 5022). The number of decay, missing and filled surfaces (DMFS) were recorded. Independent variables were demographic, socioeconomic conditions and dental care characteristics. Proportions of DMFS >0, average DMFS and its components were calculated.Results: Overall, 32.1% had decayed surfaces, with a higher proportion found in males (34.7%) and 40% higher in those living in remote areas than in those living in major city and regional areas. The prevalence of decayed surfaces varied from 37.4% (lowest income group) to 25.0% (highest income group). The mean number of decayed surfaces was three times higher in the lowest income group compared to the highest one. Uninsured people had a higher prevalence of decayed surfaces and lower mean of filling surfaces than insured group. Participants with an unfavourable pattern of dental visiting had two times higher prevalence of decay than their counterparts. Overall, three quarters (77.4%) had at least one filling in their permanent dentition. This percentage increased from 61.6% among 15-34 year olds, to 88.0% among those aged 55-74 years.Conclusion: Socioeconomic inequalities in caries experience persist in Australia. [ABSTRACT FROM AUTHOR]

Australia has a weakness in metropolitan-level governance for our major cities. With the challenges facing Australian cities and communities in the twenty-first century, re-engagement with how to improve the governance of cities will be an important factor in ensuring their liveability, sustainability and competitiveness. This paper draws on the literature, and our practitioner experience, to derive a framework and key pillars of reform to guide metropolitan governance development. This framework considers the unique characteristics of Australia's metropolitan governance, which is dominated by State and Territory governments. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence of and factors associated with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 in people with diabetes.Research Design and Methods: We identified people with diabetes in the EXamining ouTcomEs in chroNic Disease in the 45 and Up Study (EXTEND45), a population-based cohort study (2006-2014) that linked the Sax Institute's 45 and Up Study cohort to community laboratory and administrative data in New South Wales, Australia. The study outcome was the first eGFR measurement <60 mL/min/1.73 m2 recorded during the follow-up period. Participants with eGFR < 60 mL/min/1.73 m2 at baseline were excluded. We used Poisson regression to estimate the incidence of eGFR <60 mL/min/1.73 m2 and multivariable Cox regression to examine factors associated with the study outcome.Results: Of 9,313 participants with diabetes, 2,106 (22.6%) developed incident eGFR <60 mL/min/1.73 m2 over a median follow-up time of 5.7 years (interquartile range, 3.0-5.9 years). The eGFR <60 mL/min/1.73 m2 incidence rate per 100 person-years was 6.0 (95% CI 5.7-6.3) overall, 1.5 (1.3-1.9) in participants aged 45-54 years, 3.7 (3.4-4.0) for 55-64 year olds, 7.6 (7.1-8.1) for 65-74 year olds, 15.0 (13.0-16.0) for 75-84 year olds, and 26.0 (22.0-32.0) for those aged 85 years and over. In a fully adjusted multivariable model incidence was independently associated with age (hazard ratio 1.23 per 5-year increase; 95% CI 1.19-1.26), geography (outer regional and remote versus major city: 1.36; 1.17-1.58), obesity (obese class III versus normal: 1.44; 1.16-1.80), and the presence of hypertension (1.52; 1.33-1.73), coronary heart disease (1.13; 1.02-1.24), cancer (1.30; 1.14-1.50), and depression/anxiety (1.14; 1.01-1.27).Conclusions: In participants with diabetes, the incidence of an eGFR <60 mL/min/1.73 m2 was high. Older age, remoteness of residence, and the presence of various comorbid conditions were associated with higher incidence. [ABSTRACT FROM AUTHOR]

In Australia, a herpes zoster (HZ) vaccination program targeting adults aged 70 years old with catch-up for those 71-79 years began in November 2016 but there is limited information on vaccine uptake and coverage achieved since commencement. We used a national de-identified electronic primary care dataset, MedicineInsight, and extracted records from patients turning 50–90 years old during 2016–2018. Among patients considered regular attenders, with at least one visit per year in the two years prior, we estimated the crude and adjusted average monthly HZ vaccine uptake in the target population (70–79 years old) for each year since program implementation as well as cumulative vaccine coverage until December 2018. Multivariate logistic regression was used to analyse characteristics associated with higher coverage. Among 52,229, 55,034, and 57,316 regular attenders turning 70–79 years old in 2016, 2017 and 2018 respectively, the average monthly vaccine uptake rate was 5.5%, 3.3%, and 1.6% respectively. Up to 31st December 2018, the estimated cumulative vaccine coverage in regularly attending adults was 46.9% (25,791/55,034). It was substantially lower at 41.6% (27,040/65,010) using an alternate definition of a regular attender. Vaccine coverage differed by sex (women: 48.5% versus men: 45.1%, adjusted OR = 1.1, 95% CI: 1.1–1.2); by jurisdiction (compared to New South Wales: 43.7%, South Australia: 55.6%, aOR = 1.6, 95% CI (1.5–1.8); Northern Territory: 27.6%, aOR = 0.6, (0.5–0.7)); by remoteness status (compared to major cities: 47.6%, remote/very remote areas: 38.2%, aOR = 0.7, (0.6–0.8)); and by socioeconomic disadvantage (compared to most disadvantaged: 41.8%, most advantaged: 48.6%, aOR = 1.6 (1.2–2.1)). Our estimates of HZ vaccine coverage are substantially higher than the only other reports based on the Australian Immunisation Register however they still suggest that uptake is suboptimal. The use of electronic medical records can complement other data for estimating vaccine coverage in Australian adults. [ABSTRACT FROM AUTHOR]

Background: To improve the effectiveness and efficiency of health service provision in China, the National Health Commission has emphasised that training of all health service managers is essential. However, the implementation of that policy has proven challenging for various reasons, one of which is the lack of understanding of the competency requirements and gaps. The aims of the study were to develop an understanding of the characteristics and training experience of hospital managers in one major Chinese city, explore the difficulties they experience and relate them to their perceived importance of management competencies and the perceived level of their management competency.Methods: A cross-sectional, descriptive study with a three-component survey including the use of a validated management competency assessment tool was conducted with three senior executive groups (n = 498) from three categories of hospital in Jinan, Shandong Province, China.Results: The survey confirmed that formal and informal management training amongst participants before commencing their management positions was inadequate. The core competencies identified in the Australia context were applicable to the management roles in Chinese hospitals. In addition, the senior executives had low levels of confidence in their management competence. Furthermore, the data showed significant differences between hospital categories and management levels in terms of their commitment to formal and informal training and self-perceived management competence.Conclusions: The study suggests that management training and support should be provided using a systematic approach with specific consideration to hospital types and management levels and positions. Such an approach should include clear competency requirements to guide management position recruitment and performance management. [ABSTRACT FROM AUTHOR]

• A SaTScan space–time scan statistic identified statewide clusters of cryptosporidiosis. • A majority of clusters of cryptosporidiosis centred on major and regional cities. • Clusters were distributed across all five Australian remoteness categories. • Cluster formation coincided with the Australian summer months. • There was high representation of children under 5 years and females of childbearing age. Cryptosporidiosis, caused by infection with Cryptosporidium spp., is a globally distributed disease that manifests as diarrhoea for which there is no effective treatment. The protozoan parasite Cryptosporidium is difficult to detect and control, and can lead to severe disease in young children and the immunocompromised. Individual outbreaks across Australia have predominately been reported in urban areas associated with recreational water, but investigation of spatiotemporal distribution of disease is limited. This study evaluated the spatial and temporal patterns of clusters of notified cases of cryptosporidiosis in the north-eastern Australian state of Queensland, which has the highest average notified cases nationally. A spatiotemporal analysis in SaTScan of 12,263 notified cases from mid 2001 to mid 2015 identified 79 statistically significant disease clusters (P < 0.05). Analyses of annual incidence and disease cluster formation across the state illustrated the substantial randomness of clustering with no clear geographic distribution. Outbreaks were observed temporally across all latitudes and in rural and urban settings, with the majority of clusters centred in major and regional cities. Whilst clusters appeared in areas of high incidence, high incidence itself was not a predictor of clusters. Clusters generally formed during the hottest months between January and April, and cases were primarily children aged 0 to <5 years. Spatiotemporal analysis at a statewide level is an important indicator of regional disease patterns and can act as a trigger for targeted epidemiological investigation. [ABSTRACT FROM AUTHOR]

Introduction: Rural, remote, and Indigenous stroke patients have worse stroke outcomes than urban Australians. This may be due to lack of timely access to expert facilities. Objectives: We aimed to describe the characteristics of patients who underwent aeromedical retrieval for stroke, estimate transfer times, and investigate if flight paths corresponded with the locations of stroke units (SUs) throughout Australia. Methods: Prospective review of routinely collected Royal Flying Doctor Service (RFDS) data. Patients who underwent an RFDS aeromedical retrieval for stroke, July 2014–June 2018 (ICD-10 codes: I60–I69), were included. To define the locations of SUs throughout Australia, we accessed data from the 2017 National Stroke Audit. The main outcome measures included determining the characteristics of patients with an in-flight diagnosis of stroke, their subsequent pickup and transfer locations, and corresponding SU and imaging capacity. Results: The RFDS conducted 1,773 stroke aeromedical retrievals, consisting of 1,028 (58%) male and 1,481 (83.5%) non-Indigenous and 292 (16.5%) Indigenous patients. Indigenous patients were a decade younger, 56.0 (interquartile range [IQR] 45.0–64.0), than non-Indigenous patients, 66.0 (IQR 54.0–76.0). The most common diagnosis was "stroke not specified," reflecting retrieval locations without imaging capability. The estimated median time for aeromedical retrieval was 238 min (95% confidence interval: 231–244). Patients were more likely to be transferred to an area with SU and imaging capability (both p < 0.0001). Conclusion: Stroke patients living in rural areas were younger than those living in major cities (75 years, Stroke Audit Data), with aeromedically retrieved Indigenous patients being a decade younger than non-Indigenous patients. The current transfer times are largely outside the time windows for reperfusion methods. Future research should aim to facilitate more timely diagnosis and treatment of stroke. [ABSTRACT FROM AUTHOR]

Background: Information on the nature and appropriateness of antibiotic prescribing for children in hospitals is important, but scarce.Objectives: To analyse antimicrobial prescribing and appropriateness, and guideline adherence, in hospitalized children across Australia.Patients and Methods: We analysed data from the National Antimicrobial Prescribing Survey (NAPS) from 2014 to 2017. Surveys were performed in hospital facilities of all types (public and private; major city, regional and remote). Participants were admitted children <18 years old. Risk factors associated with inappropriate prescribing were explored using logistic regression models.Results: Among 6219 prescriptions for 3715 children in 253 facilities, 19.6% of prescriptions were deemed inappropriate. Risk factors for inappropriate prescribing included non-tertiary paediatric hospital admission [OR 1.37 (95% CI 1.20-1.55)] and non-major city hospital location [OR 1.52 (95% CI 1.30-1.77)]. Prescriptions for neonates, immunocompromised children and those admitted to an ICU were less frequently inappropriate. If a restricted antimicrobial was prescribed and not approved, the prescription was more likely to be inappropriate [OR 12.9 (95% CI 8.4-19.8)]. Surgical prophylaxis was inappropriate in 59% of prescriptions.Conclusions: Inappropriate antimicrobial prescribing in children was linked to specific risk factors identified here, presenting opportunities for targeted interventions to improve prescribing. This information, using a NAPS dataset, allows for analysis of antimicrobial prescribing among different groups of hospitalized children. Further exploration of barriers to appropriate prescribing and facilitators of best practice in this population is recommended. [ABSTRACT FROM AUTHOR]

Q fever (caused by Coxiella burnetii) is a serious zoonotic disease that occurs almost worldwide. Occupational contact with animals increases the risk of exposure, and Q fever vaccination is recommended for veterinary workers in Australia. This study aimed to investigate C. burnetii seroprevalence among unvaccinated veterinary workers in Australia and determine factors associated with a positive serological result. During 2014 and 2015, convenience sampling at veterinary conferences and workplace vaccination clinics was undertaken. Participants completed a questionnaire and provided a blood sample for C. burnetii serology. Participants were predominantly veterinarians (77%), but veterinary support staff, animal scientists, and administration workers also participated. Blood samples (n = 192) were analysed by an immunofluorescence assay and considered positive where the phase I or phase II IgG titre was ≥1/50. Seroprevalence was 19% (36/192; 95% CI 14%–25%). A positive serological result was significantly associated with (a) working in outer regional/remote areas (odds ratio [OR] 6.2; 95% CI 1.9–20.8; reference = major cities; p =.009) and (b) having spent more than 50% of total career working with ruminants (OR 4.8; 95% CI 1.7–13.5; reference = <15% of career; p =.025). These findings confirm an increased risk of exposure to C. burnetii compared to the general population, providing new evidence to support Q fever vaccination of veterinary workers in Australia. [ABSTRACT FROM AUTHOR]

• Utilising residual chlamydia specimens is a feasible method for HPV surveillance in Australia. • HPV results of 362 residual specimens were matched with demographic and vaccine registry data for 98.6% • We detected HPV 16/18 in 3% women, and HPV 31/33/45/52/58 in 19%; 7.8% had a positive chlamydia test. Australia has recently implemented major changes in cervical cancer prevention policies including introduction of primary human papillomavirus (HPV) screening starting at age 25, and replacement of the quadrivalent HPV vaccine with the nonavalent vaccine in the national school-based program. We assessed the feasibility and utility of conducting HPV testing in residual clinical specimens submitted for routine Chlamydia trachomatis screening, as a means of tracking HPV vaccine program impact among young sexually active women. De-identified residual specimens from women aged 16–24 years submitted for chlamydia testing were collected from three pathology laboratories in Victoria and New South Wales. Limited demographic information, and chlamydia test results were also collected. Patient identifiers were sent directly from the laboratories to the National HPV Vaccination Program Register, to obtain HPV vaccination histories. Samples underwent HPV genotyping using Seegene Anyplex II HPV 28 assay. Between April and July 2018, 362 residual samples were collected, the majority (60.2%) of which were cervical swabs. Demographic data and vaccination histories were received for 357 (98.6%) women (mean age 21.8, SD 2.0). Overall, 65.6% of women were fully vaccinated, 9.8% partially, and 24.7% unvaccinated. The majority (86.0%) resided in a major city, 35.9% were classified in the upper quintile of socioeconomic advantage and chlamydia positivity was 7.8%. The prevalence of quadrivalent vaccine-targeted types (HPV6/11/16/18) was 2.8% (1.5–5.1%) overall with no differences by vaccination status (p = 0.729). The prevalence of additional nonavalent vaccine-targeted types (HPV31/33/45/52/58) was 19.3% (15.6–23.8%). One or more oncogenic HPV types were detected in 46.8% (95% CI 41.6–52.0%) of women. HPV testing of residual chlamydia specimens provides a simple, feasible method for monitoring circulating genotypes. Applied on a larger scale this method can be utilised to obtain a timely assessment of nonavalent vaccine impact among young women not yet eligible for cervical screening. [ABSTRACT FROM AUTHOR]

Issue Addressed: The aim of this study was to use a novel approach to geographically model the relationship between socio-economic disadvantage and prevalence of profound and severe disability.Method: This study used national census data and the survey of disability, ageing and carers data to geographically model the relationship between socio-economic disadvantage and prevalence of profound and severe disability.Result: The results in this study show that there were more people living in the least disadvantaged areas (wealthiest) when compared to the most disadvantaged (poorest) areas. Whereas for people with a disability as the relative socio-economic disadvantage of the area increased, the number of people reporting any disability also increased, with the highest number coming from the most disadvantaged areas. The maps show a significant distribution with fewer cases of disability in metropolitan areas and relatively higher number in the rural area along with the higher proportion of people with disability living in the relatively more disadvantaged areas.Conclusion: Socio-economic profile is one of the key factors influencing the various aspects of health and hence should hold an important place during policy making. Policy should be formulated and implemented to help reduce the inequality by either directly aiming at the most disadvantaged group or by trying to bridge the gap between them. SO WHAT?: This paper provides a geographic visualisation of the distribution of people with profound and severe disability to help identify priority areas with high prevalence of disability. [ABSTRACT FROM AUTHOR]